Smokers face a greater risk of coronavirus and put their loved ones at risk, according to a stark warning from Public Health England.

Health chiefs said there has ‘never been a more important time’ to quit the habit than now because of the ever-worsening outbreak in Britain.

PHE also claimed family, including children, will also be at a higher risk of serious COVID-19 complications, as a result of inhaling secondhand smoke.

They based their advice on a ‘small but impactful’ study in China, which suggests smokers are more likely to see their disease progress.

But one team of experts from Wuhan – where the pandemic began – were mystified after finding smokers were less likely to catch the deadly virus in the first place.

However, leading experts who have scoured all of the available evidence collated so far say the proof is scarce and warnings are based solely on assumptions.

Scientists have called for further trials to clarify if smoking poses a real threat, but admit, in general, smokers are more susceptible to infection.

The tiny hairs inside the airways and lungs, which help move pathogens and mucus away, are often damaged by the toxic chemicals in cigarette smoke.

Smokers face a greater risk of coronavirus and put their loved ones at risk, according to a stark warning from Public Health England.

The new stance from Public Health England (PHE) comes as the death toll reaches new record highs. Of the 3,605 Britons who have died, 684 were reported in a single day

The largest study which analyses health profiles of patients is published in the New England Journal of Medicine. Of the 173 patients who had severe symptoms, 16.9 per cent of them were current smokers and 5.2 per cent had previously smoked. In comparison, of the patients with less-severe symptoms, 11.8 per cent were current smokers and 1.3 per cent were former smokers

Researchers at the Zhongnan Hospital of Wuhan University made the conclusion that only 1.4 per cent of 140 hospitalised patients were smokers

A study of 41 patients found that none of the 13 patients who needed to be admitted to ICU were current smokers. In contrast, 11 per cent (three) of those who did not need intensive care were smokers

One study of 140 coronavirus patients found that among the 58 patients who severely ill, 3.4 per cent (two people) were current smokers and 6.9 per cent (four) were former smokers. In comparison, of the 82 with milder symptoms, none were current smokers and 3.7 per cent (three) were former smokers

WHAT DO THE FIVE STUDIES LOOKING AT SMOKERS SHOW?

Leading experts who have scoured all of the available evidence collated so far say the proof smoking raises the risk of coronavirus is limited.

The group of experts even admitted warnings made by health chiefs were based mainly on assumptions, given the known infection risks of smoking.

The team, based at the Harvard School of Dental Medicine and the University of Crete in Greece, reviewed five of the first studies on smoking and COVID-19.

Research showed smokers do face a greater risk of suffering complications but others suggested they were less likely to be infected in the first place.

The review of the evidence, led by Harvard’s Dr Constantine Vardavas, was published in the journal Tobacco Induced Diseases.

Study 1: Wei Liu and colleagues at three tertiary hospitals in Wuhan, China.

None of the 13 patients who needed to be admitted to ICU were current smokers. In contrast, 11 per cent (three) of those who did not need intensive care were smokers.

ARE THE STUDIES REPRESENTATIVE OF THE REAL SMOKING POPULATION?

In all of the studies, fewer than 15 per cent of the patients were smokers – a figure that clashes with China’s smoking rate.

The WHO says 300million people in China smoke – roughly a fifth of the country’s total population and a third of the world’s total.

Data from a national survey conducted by China in 2015 found up to 60 per cent of men between the ages of 45 and 64 smoke.

British researchers were clueless as to why the NEJM study, the largest studies on this topic, had such low rates of smokers (12.6 per cent), especially given 28 per cent of patients were between 50 and 64.

The new stance from Public Health England (PHE) comes as the death toll reached 3,605 with a record 684 deaths announced.

In a statement, the government body said: ‘If you smoke, you are not only putting yourself at greater risk of developing severe disease from the COVID-19 virus, but those around you exposed to second hand smoke, including children, are also put at increased risk.

‘The repetitive hand to mouth movement provides an easy route of entry for the virus, putting smokers at greater risk of contracting COVID-19.’

Of the 173 patients who had severe symptoms, 16.9 per cent of them were current smokers and 5.2 per cent had previously smoked.

In comparison, of the patients with less-severe symptoms, 11.8 per cent were current smokers and 1.3 per cent were former smokers.

In a group of patients that either needed mechanical ventilation, admission to an intensive care unit, or ultimately died, a quarter were current smokers – more than twice the rate than in patients who did not have such adverse outcomes.

It confirmed the findings of a smaller study in Wuhan which showed more than ten per cent of COVID-19 patients who were severely ill were either smokers or former smokers.

In comparison, of those with milder symptoms, none we current smokers. Just under four per cent had smoked previously, the findings in Allergy show.

Another study of 191 patients, published in The Lancet, showed a higher proportion of smokers among victims (nine per cent) than survivors (four per cent).

But not all the evidence suggests a negative prognosis for smokers. A study published in The Lancet made no connection between serious COVID-19 illness and smokers.

Among 41 patients, none of the 13 who needed to be admitted to intensive care were current smokers, the team in Wuhan said. But there were smokers in the group who fared better.

Similarly, researchers at Zhongnan Hospital of Wuhan University – whose work was not included in the meta-analysis – were mystified after finding smokers were less likely to catch the deadly virus in the first place.

They made the conclusion that only 1.4 per cent of 140 hospitalised patients were smokers.

Writing in the journal The Lancet, the researchers added: ‘The exact underlying causes of the lower incidence of COVID‐19 in current smokers are still unknown.’

But they admitted: ‘The outcome of SARS‐CoV‐2 infection in smokers may be more severe.’

Although further research is warranted, smoking is ‘most likely associated with the negative progression and adverse outcomes of COVID-19’, the Harvard team concluded in the journal Tobacco Induced Diseases.

Doctors across the world have echoed the concern and called for further trials, aware that smokers generally are in danger of picking up more infections.

Dr James Gill, a locum GP and honorary clinical lecturer, Warwick Medical School, said: ‘Possibly one of the biggest reasons smokers are at increased risk of respiratory infections is the impairment and death of the cilia in the airways and lungs.

‘In simple terms, the airways are lined with cilia – small brush-like hairs – these structures provide an absolutely vital function in moving mucous, inhaled debris and potentially infectious agents out of the airways and lungs before an infection can take hold.’

Dr Tom Wingfield, a senior clinical lecturer and honorary consultant physician, Liverpool School of Tropical Medicine (LSTM), highlighted the tendency of smokers to have a health condition.

They have higher rates of high blood pressure, high disease and chronic lung, ‘all of which themselves are risk factors for severe COVID-19’.

But Professor Gordon Dougan, department of medicine, University of Cambridge, said it’s ‘too early’ to make a call on whether smoking impacts COVID-19 infection.

‘However, we do know that smoking does impair normal lung function in many ways,’ he said.

Professor John Newton, director of health improvement at PHE said: ‘In light of this unprecedented COVID-19 pandemic, there has never been a more important time to stop smoking. Not only for your own health but to protect those around you. It will also help alleviate the huge pressures on the NHS.’

WHY MAY SMOKERS BE MORE AT RISK OF SEVERE CORONAVIRUS?

‘There are many interlocking factors as to why smoking reduces the body’s ability to fight an infection.

‘Possibly one of the biggest reasons smokers are at increased risk of respiratory infections is the impairment and death of the cilia in the airways and lungs.

‘In simple terms, the airways are lined with cilia – small brush-like hairs – these structures provide an absolutely vital function in moving mucous, inhaled debris and potentially infectious agents out of the airways and lungs before an infection can take hold.’

Increased levels of carbon monoxide in the blood, a by-product of smoking, blocks the blood’s ability to carry oxygen to cells in the body.

It puts smokers at a pre-disposed disadvantage if they catch coronavirus, considering the disease leaves patients unable to get enough oxygen into the bloodstream due to lung inflammation.

Dr Tom Wingfield, a senior clinical lecturer and honorary consultant physician, Liverpool School of Tropical Medicine (LSTM), said: ‘Smoking both increases someone’s vulnerability to infection (repetitive touching of hand-to-face and hand-to-mouth) and reduces their ability to fight against it resulting in more severe disease.’

He highlighted the tendency of smokers to have a health condition, such as high blood pressure, high disease and chronic lung, ‘all of which themselves are risk factors for severe COVID-19’.

Professor Gordon Dougan, department of medicine, University of Cambridge, said: ‘The real danger lies in the lung and systems damage COVID causes. It will make people more vulnerable to secondary bacterial and viral infections. It is known that lung damage per say does that.

‘I would recommend that people stop smoking but, having lost my own sister to lung cancer, know it is not easy.’

…THEN WHY ARE THERE SUCH LOW NUMBERS OF SMOKERS GETTING ILL WITH CORONAVIRUS?

A nationwide Chinese study looking at nearly 1,600 hospitalised coronavirus patients found just 7 per cent were current or former smokers.

Researchers from the Guangzhou Medical University analysed patients from 575 hospitals in 31 provinces.

It found that out of 1,590 COVID-19 sufferers, just 111 currently or used to smoke cigarettes.

More than a quarter (27 per cent) of the Chinese population smoke, according to a 2015 survey.

More than half of male adults (52 per cent) smoke, whereas just 3 per cent of women have taken up the habit.

The finding suggests smokers are less at risk of falling seriously ill with the bug. The study was published in the European Respiratory Journal.

One study in Wuhan – where the pandemic began – actually discovered smokers were more likely to see their disease progress.

Researchers at the Zhongnan Hospital of Wuhan University made the conclusion that only 1.4 per cent of 140 hospitalised patients were smokers.

Ya-dong Gao and colleagues wrote in the journal Allergy: ‘Interestingly, there were only two current smokers and seven past smokers.’

Of the nine patients classed as smokers, three had non-severe symptoms. The other six were classed as having severe symptoms.

Writing in the journal, the researchers added: ‘The relationship between smoking and coronavirus infection is not clear.

‘The exact underlying causes of the lower incidence of COVID‐19 in current smokers are still unknown.’

British researchers say they have no idea why the NEJM study had such low rates of smokers, especially given 28 per cent of patients were between 50 and 64 and around 60 per cent were men.

One reason they suggested was that it could be down to the demographic of the patients analysed – 43 per cent lived in Wuhan.

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